This is a 46-year-old patient who had been experiencing a feeling of weight in her abdomen for several months. Later, events of genital bleeding were added. Finally, this symptomatology was much more severe, much more acute, so she consulted a doctor. gynecologist who, upon examining her, found the fibroid aborted in the vagina, that is, still attached by its pedicle to the uterine cavity, and proposed a hysterectomy… Fortunately, she had a friend who had been a patient of ours at Creafam Veracruz and recommended she attend the consultation. to have a more conservative alternative.

Well then, although our patient already had a diagnosis, we proceed to do the evaluation. First place the vaginal mirror to confirm the presence of the tumor in the vagina, I confirmed that it was a fibroid, you can move it away a little and verify that the pedicle did indeed come from the cervical canal, that it was not a cervical fibroid but rather It came from inside the canal. And then what did I do? Later, perform an abdominal ultrasound because it is also important to confirm if it was a single tumor. Abdominally, we verified that there were no more subserous or intramural types of fibroids.

In her case, I also did a vaginal ultrasound to try to evaluate in more detail the presence… Of the path through the cervix and that there were other submucosal fibroids. It was curious because although the pedicle itself could not be seen, the cervix could be seen, the path of the cervix between open and occupied. So in that way, combining clinical and ultrasound information, we determined that it was a single, submucosal fibroid, aborted into the vagina.

Uterine fibroids can be classified by their location into three types: There are subserosal fibroids that grow outside the uterine cavity, intramural fibroids that grow in the thickness of the uterine muscle, and submucosal fibroids that grow into the cavity.

In the case of our patient, it was a pedunculated submucosal myoma that grew and finally, what happened? The uterus, upon detecting the presence of that foreign body, began to contract to expel it. As time went by, the pedicle that joined the fibroid to the uterine body stretched, stretched, until finally, when it was already at the level of the neck, it was expelled, then the tumor as such was expelled towards the vagina but the pedicle that connects it still remained attached to the uterine cavity, thus it is classified as an aborted submucosal fibroid, even more so it was attached to the cavity.

It is important to make it clear that although the term “aborted” sounds like it was already expelled, the fibroid was actually still attached to the uterine body, that is, it is not aborted as can occur in cases of obstetrics or in the case of pregnancies. The fibroid is in the vagina but remains attached to the uterus. It is impossible for a fibroid to be expelled naturally or spontaneously outside the uterine body since it always remains attached to the muscle fibers and needs to be removed with surgery. And this clarification is very important! Because they often write to us asking similar questions: Can I take any medication? Can we drink some kind of tea to help me expel the fibroid? or someone once told me that taking X medication expelled the fibroid, it eliminated itself… That doesn’t happen. Submucosal fibroids can only be removed with surgery. So, finding the fibroid inside the vagina we could think “Well, we can fix it, cut the base there and with that we solve the problem, after all the fibroid was already outside”… The issue is that the pedicle It is very thick, therefore it is very vascularized, if we do that we can trigger hemorrhage that can be very dangerous so the strategy is different.

So we took our patient to the operating room and under the effects of epidural anesthesia so that she would not have any discomfort, any pain, we addressed the fibroid. First we fix the tumor with a suture, we place vasopressin to reduce vascularization and the risk of bleeding and then we enter with the hysteroscope.

Hysteroscopy allows us to directly visualize the cervical canal and the uterine cavity and through this system we can use surgical instruments, whether electric or scissors. In this case we approached with the hysteroscope, we evaluated the entire path of the pedicle and then with electrosurgery we electrocoagulated the entire path of the pedicle in order to cut the vascularization, once we had devascularized it then we proceeded to cut the pedicle with the safety of that it was not going to bleed, once we resected the entire pedicle we finally removed the fibroid and there were no bleeding complications, which is the main one that had to be avoided.

Many times patients write to us asking us about this type of surgery, if we only see patients who want fertility, our patient already had three children, it is really a gynecological disorder that was causing pain and bleeding problems that had to be resolved, it doesn’t matter. For example, we performed a hysterectomy, you say “You remove the uterus, you solve the problem.” At the end of the day, this is a 46-year-old woman who already has children, who already has complete parity, it is really not the same to perform an outpatient surgery. where we only remove the tumor as was the case in this case, compared to a much larger surgery that requires hospitalization, such as a hysterectomy, which also implies the risk of more surgical complications or long-term complications, such as: Decrease in strength pelvic floor, some women may experience difficulty with their sexual activity or even urinary incontinence in the future, so offering more conservative alternatives to solve a problem of this type is a first-rate alternative.

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